Biomedical subjects
Publications and source records attributed to J Kraft-Kinz.
Surgical therapy of acute pancreatitis is indicated only in necrotising inflammation. The indication, moment and choice of operation are discussed. The results of surgery in 71 patients treated because of acute necrotising pancreatitis are demonstrated. In cases of necrotising lethality was 26.5%; in total necrotising 86.5%.
A follow-up study of 46 cases of isolated coarctation of the aorta (age at surgical treatment 1 to 48 years) is presented. The late postoperative blood pressure was the higher the later surgical treatment was carried out. When surgical treatment was carried out at an age of more than 14 years, an increase of the residual hypertension rate was observed. A relatively low rate of residual hypertension can be expected after correction at about 6 to 10 years. Surgical treatment in infancy does not seem to have beneficial effects since according to other reports correction at this age does not reduce the residual hypertension rate essentially. Apart from the elevated residual hypertension rate surgical treatment at an advanced age generally has a lowering effect on blood pressure values.
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The types of injuries to 313 automobile accident victims, especially thorax injuries, are compared. Independent of seat belt use (42%), there was in general a higher degree of injury. Those wearing seat belts had a markedly less severe AISm (median degree of injury of body region) and less severe thorax injury. Severe thorax injury was first found at speeds greater than 24 km/h above average. Severer thorax injury is to be expected with defective seat belts (AISm = 1.25) than with properly functioning belts (AISm = 0.32).
Congenital heart lesions are found in 0.8% of all newborns; four-fifths of them are correctable. Two thirds of all surgical procedures are done in acyanotic malformations, mainly in septal defects, patent ductus arteriosus, coarctations of the aorta and valvular stenosis. Within the last twenty years corrective repair has been established with good results in these lesions. Therapeutic problems still remain in cases of late diagnosis and in some rare and complex anomalies like malformations of the aortic arch, of the coronary arteries, in some types of aortopulmonary window and atrioventricular canal. Surgery becomes urgent in babies suffering from severe heart disease because of progressive pulmonary hypertension, inadequate growth or severe heart failure (despite intensive medical treatment). For certain lesions corrective repair (patent ductus arteriosus, coarctation) is definitely indicated, for others (ventricular septal defect, atrioventricular canal) urgent palliation or early total repair is debatable. In most patients with uncomplicated lesions treated in time during childhood a low operative mortality below 1% was observed. A higher mortality rate was found (10 to 50%) in patients with pulmonary artery disease or associated pulmonary lesions. A significantly higher mortality could also be observed in the advanced age group (4.7%) and in infants below one year of age (11,5%), underlining the important point of the age at operations. Recurrence of lesions occured in 1% of our patients after closure of ventricular septal defects, reconstructions of mitral valve disease and early corrected coarctations. Nevertheless, most of these patients can expect a normal growth, life span and ability to work.
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Complications (stenosis, intestinal obstruction, abscess or fistula formation, inflammation, etc.) of colonic diverticulitis are seen in 35% of patients affected. Multiple operative procedures involve less risk than surgery performed in a single session. The mortality in emergency surgery is reported to be up to 40%, while subsequent resection of the diseased colon involves the usual mortality of surgery on the colon, i.e. 1.5-9%. The vital factor in this illness is the earliest possible surgical treatment of the diseased diverticulum, so that the extremely problematical complications can be avoided.
In summary, rapid atrial pacing prior to surgery may be able to assess LVF and the degree of coronary insufficiency by measuring lactate production. Functional contraction abnormalities of the left ventricle are described by the anginal depression of the LVF, whereas a preanginal depression should be a sign of organic, fibrotic impairment of myocardial function. In cases of the former, after successful bypass surgery, a normal LVF may be observed. Moreover, myocardial metabolism is normalised. In the latter group, despite clinical improvement, functional abnormalities can persist.
In 1898 the first radical operation for carcinoma of the pancreas was performed by Codivilla in Bologna. Kausch followed in 1913 and Whipple perfected the technique of duodenopancreatectomy. The central position of the pancreas causes technical difficulties. Carcinoma of the head of the pancreas frequently causes icterus, which quite often limits the primary radical operation. Radical removal of carcinoma of the head of the pancreas is only possible if the limits of the organ have not been passed. Preservation of a part of the pancreas is essential for the metabolism. The average primary mortality of the radical operation is around 25 percent, having fallen significantly in the last few years. The 5-years recovery rate is a bare 10 percent.
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